Four-factor prothrombin complex concentrate is not inferior to andexanet alfa for the reversal or oral factor Xa inhibitors: An Eastern Association for the Surgery of Trauma multicenter study.

Background: Andexanet alfa (AA) is the only FDA-approved reversal agent for apixaban and rivaroxaban (DOAC). There are no studies comparing its efficacy with four-factor prothrombin complex concentrate (PCC). This study aimed to compare PCC to AA for DOAC reversal, hypothesizing noninferiority of PCC.

Patient reported outcomes of emergency general surgery procedures.

Background: Emergency general surgery (EGS) involves care of a patient's often previously unknown disease in the setting of an unplanned interaction with the healthcare system. This leads to challenges collecting and interpreting patient reported outcome measures (PROMs).

Methods: We performed a qualitative and mixed methods study using semi-structured interviews during the index hospitalization and at 6-12 months to capture peri-operative patient experiences.

Effects of novel Coronavirus (COVID-19) on presentation, management, and outcomes of acute cholecystitis at an academic tertiary care center cholecystitis management during COVID-19.

Background: The COVID-19 pandemic necessitated adjustments to nearly all aspects of healthcare, including surgical care. The effects of these adjustments have not been well studied on acute surgical problems conventionally managed non-electively in large, tertiary care centers.

Methods: A retrospective analysis of admitted patients with acute cholecystitis at a US academic tertiary care center was performed.

Does lower extremity fracture fixation technique influence neurologic outcomes in patients with traumatic brain injury? The EAST Brain vs. Bone multicenter trial.

Objective: This study aimed to determine whether lower extremity fracture fixation technique and timing (≤24 vs. >24 hours) impact neurologic outcomes in TBI patients.

Methods: A prospective observational study was conducted across 30 trauma centers.

Imaging acute cholecystitis, one test is enough.

Background: Patients with right upper quadrant pain are often imaged using multiple modalities with no established gold standard. A single imaging study should provide adequate information for diagnosis.

Methods: A multicenter study of patients with acute cholecystitis was queried for patients who underwent multiple imaging studies on admission.

Academic Medical Centers Experienced Higher Rates of Post-Operative Health-Care-Associated Infections during the COVID-19 Pandemic: A Post Hoc Analysis of an Eastern Association for the Surgery of Trauma Multicenter Trial.

We sought to examine health-care-associated infections (HAIs) among patients undergoing an appendectomy at academic medical centers (AMCs) and non-AMCs during the coronavirus disease 2019 (COVID-19) peri-pandemic. We hypothesized that AMCs would have higher rates of post-operative HAIs during the first wave of the pandemic. We performed a post hoc analysis of a prospective, observational, multi-center study of patients aged >18 years who underwent an appendectomy for acute appendicitis before (pre-CoV), during (CoV), and after pandemic restrictions were lifted (post-CoV).

Occult traumatic pneumothorax: Is routine follow up chest X-ray necessary?

Background: Occult pneumothoraces (OPTX) are pneumothoraces that are not seen on chest X-ray (CXR) but visualized on computerized tomography (CT) scan. OPTX are frequently discovered during the initial trauma evaluation, there is a paucity of evidence based guidelines on how they should be further monitored. In this study we hypothesized that the practice of obtaining routine CXR for the surveillance of OPTX does not alter clinical management.

Revision of the AAST grading scale for acute cholecystitis with comparison to physiologic measures of severity.

Background: Grading systems for acute cholecystitis are essential to compare outcomes, improve quality, and advance research. The American Association for the Surgery of Trauma (AAST) grading system for acute cholecystitis was only moderately discriminant when predicting multiple outcomes and underperformed the Tokyo guidelines and Parkland grade. We hypothesized that through additional expert consensus, the predictive capacity of the AAST anatomic grading system could be improved.

Sex-based differences in helmet performance in bicycle trauma.

Objectives: To determine the existence of sex-based differences in the protective effects of helmets against common injuries in bicycle trauma.

Methods: In a retrospective cohort study, we identified patients 18 years or older in the 2017 National Trauma Database presenting after bicycle crash. Sex-disaggregated and sex-combined multivariable logistic regression models were calculated for short-term outcomes that included age, involvement with motor vehicle collision, anticoagulant use, bleeding disorder and helmet use.

Multicenter validation of the American Association for the Surgery of Trauma grading scale for acute cholecystitis.

Background: The American Association for the Surgery of Trauma (AAST) patient assessment committee has created grading systems for emergency general surgery diseases to assist with clinical decision making and risk adjustment during research. Single-institution studies have validated the cholecystitis grading system as associated with patient outcomes. Our aim was to validate the grading system in a multi-institutional fashion and compare it with the Parkland grade and Tokyo Guidelines for acute cholecystitis.

Spirometry not pain level predicts outcomes in geriatric patients with isolated rib fractures.

Background: Geriatric patients with rib fractures are at risk for developing complications and are often admitted to a higher level of care (intensive care units [ICUs]) based on existing guidelines. Forced vital capacity (FVC) has been shown to correlate with outcomes in patients with rib fractures. Complete spirometry may quantify pulmonary capacity, predict outcome, and potentially assist with admission triage decisions.

Getting used to being a patient: the postoperative experience of living liver transplant donors.

Context: Living donor liver transplant is a viable option for eligible persons in need of a liver transplant, but little is known about the hospitalization experience of patients undergoing hepatectomy for transplant donation.

Objective: To explore the hospital experience of patients recovering from donor hepatectomy.

Design: A qualitative interpretive descriptive design was used to understand the hospital experience of patients recovering from donor hepatectomy.

Innovative solutions: using case studies to generate increased nurse's clinical decision-making ability in critical care.

Learning to care for critically ill patients requires a high level of critical thinking, clinical decision-making ability, and a substantial knowledge base. At this nursing school, an elective Critical Care Nursing course for last-semester seniors was designed to include active learning strategies, focusing on the use of case studies to facilitate learning. Results indicate significantly improved final examination scores for those involved with the case-study pedagogy.